49例儿童重症肾综合征出血热的流行病学及临床特征分析

Epidemiological and clinical characteristics of 49 children with severe hemorrhagic fever with renal syndrome

目的了解重型、危重型肾综合征出血热(HFRS)患儿流行病学特征和临床特点,积累儿童重型、危重型HFRS的诊治经验。方法采用回顾性分析方法,收集2019年1月至2021年12月西安交通大学附属儿童医院感染科收治的49例确诊HFRS且分型为重型、危重型的患儿临床病历资料,分析患儿流行病学特点、临床表现、检验检查、诊疗转归等。结果 49例重症HFRS患儿中,男∶女为3.45∶1(38∶11);中位年龄10岁8个月,其中占比最高的年龄段为6~12岁。发病月份以11、12月为发病高峰(75.51%)。居住地以农村为主,共39例(79.59%)。全部患儿起病均有发热,消化道症状(呕吐、腹痛、腹泻,81.63%)及皮肤黏膜充血潮红(77.55%)常见,典型头痛、腰痛和眼眶痛(三痛)症状仅占30.6%(15例)。血常规中白细胞升高42例(85.71%),血小板降低47例(95.91%)。降钙素原升高48例(97.95%)。谷丙转氨酶升高49例(100%),白蛋白低于30 g/L的病例38例(77.55%),尿素氮升高34例(69.38%),肌酐升高47例(95.91%),肌酸激酶同工酶升高41例(83.67%)。49例患儿均出现不同程度的电解质紊乱,其中以低钠(91.83%)、低钙(85.71%)最为常见。尿蛋白检出阳性47例(95.91%),尿红细胞检出阳性38例(77.55%)。泌尿系超声检查发现肾脏及双肾周围异常43例(91.48%)。28例(58.33%)患儿出现心电图异常。49例患儿均临床治愈。结论重症HFRS以6~12岁农村男性患儿为主,临床症状以发热及消化道症状为主,典型三痛症状缺乏,当出现白细胞计数、降钙素原明显升高、血小板计数明显降低、肝肾功能受损及电解质紊乱时应高度怀疑重症病例,早期识别重症患儿并积极救治对患儿的预后至关重要。

Objective To understand the epidemiological and clinical characteristics of children with severe and critical hemorrhagic fever with renal syndrome(HFRS),and to accumulate experience in the diagnosis and treatment of severe and critical HFRS in children.Methods A retrospective analysis method was used to collect the clinical data of 49 children diagnosed with HFRS,who were admitted to the Department of Infectious Diseases,Children′s Hospital Affiliated to Xi′an Jiaotong University from January 2019 to December 2021 and classified as severe or critical group.The epidemiological data,characteristics,clinical manifestations,laboratory examinations,diagnosis and treatment outcomes of the children were analyzed.Results Among the 49 children with severe HFRS,the ratio of male∶female was 3.45∶1(38∶11),the median age was 10 years and 8 months old,and the highest proportion was 6-12 years old.The peak incidence was in November and December(75.51%).Most of them lived in rural areas,with a total of 39 cases(79.59%).All patients had fever onset,gastrointestinal symptoms(vomiting,abdominal pain,diarrhea,81.63%)and hyperemia of skin and mucous membranes(77.55%)were common,but typical headache,backache pain and orbital pain(three pains)only accounted for 15 cases(30.6%).Laboratory test results:the white blood cells in routine blood increased in 42 cases(85.71%),while the platelets decreased in 47 cases(95.91%).The procalcitonin was increased in 48 cases(97.95%).The alanine aminotransferase was elevated in 49 cases(100%),while the albumin of 38 cases(77.55%)were lower than 30 g/L.The urea nitrogen increased in 34 cases(69.38%),and the creatinine increased in 47 cases(95.91%).The creatine kinase isozyme was elevated in 41 cases(83.67%).Forty-nine children had different degrees of electrolyte imbalance,among which low sodium(91.83%)and low calcium(85.71%)were the most common.The urine protein was positive in 47 cases(95.91%),and the urine red blood cell was positive in 38 cases(77.55%).Ultrasonography of the urinary system revealed abnormalities in the kidneys and surrounding kidneys in 43 cases(91.48%).Twenty-eight(58.33%)patients had abnormal electrocardiogram.All the 49 patients were clinically cured.Conclusion Severe HFRS is mainly in rural male children aged 6-12 years,mainly with fever and gastrointestinal symptoms,lack of typical three pain symptoms.When white blood cell count and procalcitonin significantly increased,platelet count significantly decreased,liver and kidney function impaired and electrolyte imbalance,severe cases should be highly suspected.Early identification of critically ill children and active treatment are critical to their prognosis.